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Pancreatic Mucinous Ductal Ectasia A clinical study of four patients.

Tae Sung SOHN ; Jong Riul LEE ; Jae Hyung NOH ; Seong Ho CHOI ; Yong Il KIM ; Byung Boong LEE ; Jong Gyun LEE ; Soon Jin LEE ; Young Hye KO

Journal of the Korean Surgical Society.1998;54(5):756-764.

Four cases of mucinous ductal ectasia of the pancreas are presented, along with a review of the literature. Mucinous ductal ectasia is a clinicopathologic entity characterized by dilation and filling of the main pancreatic duct or its side branches with thick, viscid mucus, leading to recurrent acute pancreatitis or symptoms that mimic chronic pancreatitis. Three of the patients were male (M:F=3:1) and the patients were 54~74 years old. The symptoms of two patients were abdominal pain and they had a frequent admission history due to pancreatitis. One patient had jaundice, and one patient presented no symptoms. In all of the patients, the tumor was located in the read of the pancrease and the size of tumor was about 3 cm. A total pancreatectomy was performed, and three pancreatico-duodenectomy were performed. The pathologic report revealed that two cases were malignant and two cases were borderline malignant. The tumor marker did not correlate with the presence of malignancy. Because mucinous ductal ectasia is recognized as a premalignant disease, the treatment of choice is pancreatic resection.
Abdominal Pain ; Dilatation, Pathologic* ; Humans ; Jaundice ; Male ; Mucins* ; Mucus ; Pancreas ; Pancreatectomy ; Pancreatic Ducts ; Pancreaticoduodenectomy ; Pancreatitis ; Pancreatitis, Chronic ; Pancrelipase

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A Case of Heterotopic Ossification in Mesentery of Intestine.

Tae WooK KANG ; Si Youl JUN ; Tae Soo CHANG ; O Jun KWON ; Byung Heon KIM

Journal of the Korean Surgical Society.1998;54(5):752-755.

Primary heterotopic ossification has been previously noted in abdominal laparotomy scars, but the presence of ectopic bone within the peritoneum is extremely rare and chracterized by new bone formation in a tissue which does not normally undergo ossification. Our patient in a 59-year-old man who underwent operation for acute cholecystitis had formation of heterotopic bone involving mesentery of intestine. The features of various types of ectopic calcification are discussed, and several theories concerning the pathogenesis and treatment of heterotopic ossification are examined.
Cholecystitis, Acute ; Cicatrix ; Humans ; Intestines* ; Laparotomy ; Mesentery* ; Middle Aged ; Ossification, Heterotopic* ; Osteogenesis ; Peritoneum

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A Case of Bleeding Vascular Malformation of the Jejunum.

Ki Ho PARK ; Yang Il KIM ; Yong Oon YOO ; Sung Hwan PARK ; Han Il LEE ; Dae Hyun JOO ; Ho Gak KIM ; Nak Kwan SUNG

Journal of the Korean Surgical Society.1998;54(5):748-751.

Vascular malformations are known by several names, such as angiodysplasia, vascular ectasia, arteriovenous malformation, and telangictasia. Arteriovenous malformations may occur anywhere in the gastrointestinal tract. The large intestine is the most commonly involved location, usually on the right side. Arteriovenous malformations, which consist of enlarged, tortuous and dilated, often thin-walled blood vessels, usually occur in the submucosa or mucosa. Occasionally, they can cause recurrent and even massive hemorrhage. The authors treated a case of angiodysplasia in the upper jejunum, which caused massive bleeding. A 67-year-old female patient was admitted because of massive lower gastrointestinal bleeding. The bleeding point was found by angiography, injection of methylene-blue dye, and intraoperative endoscopy. The bleeding lesion in jejunal segment was resected, and end-to-end anastomosis was performed. The postoperative course was uneventful, and the patient was discharged on the 10th postoperative day.
Aged ; Angiodysplasia ; Angiography ; Arteriovenous Malformations ; Blood Vessels ; Dilatation, Pathologic ; Endoscopy ; Female ; Gastrointestinal Tract ; Hemorrhage* ; Humans ; Intestine, Large ; Jejunum* ; Mucous Membrane ; Vascular Malformations*

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Papillomatosis of the Nipple: A case report.

Sung Hoo JUNG

Journal of the Korean Surgical Society.1998;54(5):743-747.

Papillary lesions of the nipple are extremely rare. These lesions are not associated with a positive family history of or other risk factors for breast carcinomas. Papillary lesions of the nipple tend to assume one or more of three distinct morphologic growth patterns. These patterns include sclerosing papillomatosis, papillomatosis adenosis, and adenosis. A nipple papilloma initially presents itself as a bulge just beneath the nipple and enlarges slowly over months to years before causing symptoms. Patients present with nipple erosions, ulcerations, or masses and often have serous or bloody discharge. Because of this constellation of symptoms, it is often a challenge to differentiate a papilloma of the nipple from Paget's disease or eczematous dermatitis. Complete excision of the papillary lesion is sufficient. The author experienced papillomatosis of nipple and got good results postoperatively. A 55-year-old woman presented with multiple lobulated small masses and erosion of the left nipple. At first, we diagnosed the lesion as Paget's disease or eczematous dermatitis. Later, a wedge biopsy revealed the papilloma. A complete excision of the papillary lesion was performed.
Biopsy ; Breast Neoplasms ; Eczema ; Female ; Humans ; Middle Aged ; Nipples* ; Papilloma* ; Risk Factors ; Ulcer

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Coagulation Factor Abnormality of Deep Vein Thrombosis in Korea.

Dong Ik KIM ; Seung HUH ; Hang Seok CHANG ; Tae Sung LEE ; Jun Bong CHANG ; Jin Hyun JOH ; Yong Il KIM ; Byung Boong LEE

Journal of the Korean Surgical Society.1998;54(5):738-742.

A deep vein thrombosis(DVT) is responsible for a number of significant medical problems including pulmonary embolisms. The factors that cause DVT have been studied by many investigators. The cases of 31 DVT patients, 19 males and 12 females, who were treated from January 1994 through January 1996, were reviewed. The mean age was 47.3 15.9 years. Four cases(12.9%) affected the right leg, 25 cases(80.6%) on the left leg, and 2 cases(6.5%) the portal vein and the mesenteric vein. Among the 29 lower extremity DVT cases, 16 cases(51.6%) showed ipsilateral iliac vein thromboses and 1 case(3.2%) showed an inferior vena cava thrombosis. Five cases(16.1%) had a history of an explo-laparotomy, 2 cases(6.5%) had a history of immobilization, 1 case(3.2%) had a history of trauma to the involved leg, and 2 cases(6.5%) had a history of collagen disease. However, 21 cases(67.7%) had no history of any predisposing factors. Five cases(16.1%) were confirmed as protein C deficiency, 3 cases(9.7%) as protein S deficiency, 4 cases(12.9%) as antithrombin III deficiency, 3 cases(9.7%) as plasminogen deficiency, and 6 cases(19.4%) as -2 antiplasmin deficiency. Ten(32.3%) of the 31 cases had multiple coagulation factor deficiency. Three patients(9.7%) had been inserted with Greenfield filter into the inferior vena cava. Initially, unfractionated heparin was injected intravenously under the control of the activated partial thromboplastin time(aPTT) until the warfarin effect reached INR 1.75~2.0. Only 5 of the 31 cases agreed to a family to study to detect any possible coagulation factor abnormality. Three of these 5 families showed coagulation factor abnormality. Our results show that more extensive study on DVT is needed in the Korean population.
Antithrombin III ; Antithrombin III Deficiency ; Blood Coagulation Factors* ; Causality ; Collagen Diseases ; Female ; Heparin ; Humans ; Iliac Vein ; Immobilization ; International Normalized Ratio ; Korea* ; Leg ; Lower Extremity ; Male ; Mesenteric Veins ; Plasminogen ; Portal Vein ; Protein C ; Protein C Deficiency ; Protein S ; Protein S Deficiency ; Pulmonary Embolism ; Research Personnel ; Thromboplastin ; Thrombosis ; Veins ; Vena Cava, Inferior ; Venous Thrombosis* ; Warfarin

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The Vascular Injuries During Laparoscopic Surgery.

Kyung Sik KIM ; Jung Ku KANG ; Suk Ju KIM ; Woo Jung LEE ; Byong Ro KIM

Journal of the Korean Surgical Society.1998;54(5):733-737.

Laparoscopic procedures have been accepted as a safe, effective treatment modalities and are well tolerated by patients. Although incidences of major vascular injuries following laparoscopic procedures are rare, they are important in that they can cause serious morbidity or death. From February 1993 to November 1996, we experienced 3 cases of vessel injury during laparoscopic surgery. In the first case, the right hepatic artery was injured during a laparoscopic cholecystectomy. We converted to open surgery immediately. The second case involved a scrotal hematoma which developed immediately after a transabdominal preperitoneal(TAPP) laparoscopic hernia repair. We opened the inguinal region anteriorly 2 days after the surgery and confirmed the bleeding from the inferior epigastric artery. In the third case, the left common iliac artery was injured during trocar insertion for a laparoscopic appendectomy, and it was unnoticed. One hour after the operation, we had to open the abdomen due to fresh bleeding from the drainage. All three patients had no morbidity or mortality after the definite surgery. We conclude that if there is any suspicion of vascular injuries, immediate conversion to open procedures is mandatory, and appropriate vascular surgical techniques should be applied to lessen the morbidity and the mortality.
Abdomen ; Appendectomy ; Cholecystectomy, Laparoscopic ; Drainage ; Epigastric Arteries ; Hematoma ; Hemorrhage ; Hepatic Artery ; Herniorrhaphy ; Humans ; Iliac Artery ; Incidence ; Laparoscopy* ; Mortality ; Surgical Instruments ; Vascular System Injuries*

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Clinical Study of Simple and Strangulated Intestinal Obstruction.

Sung Keun PARK ; Cheol Ho PARK ; Jong Chan LEE

Journal of the Korean Surgical Society.1998;54(5):723-732.

Ninety-six cases of intestinal obstruction that were surgically managed at the Department of General Surgery, Pohang St. Mary,s Hospital, during the 5 years from July 1991 to June 1996 were analyzed, and the results are as follows; 1) The most frequent age group was the first decade(32.3%), and the male to female ratio was 2.56:1. The most prevalent age group for strangulated intestinal obstructions was the third decade, and the male to female ratio was 1:2.93. 2) The main causes of intestinal obstruction were postoperative adhesion(41.7%) and incarcerated hernia(18.8%). The main causes of simple intestinal obstruction were postoperative adhesion(37%) and incarcerated hernia(18.5%) and those of strangulated intestinal obstruction were postoperative adhesion (66.6%) and incarcerated hernia(20%). 3) Previous abdominal operations leading to an intestinal obstruction were appendectomies(34.6%) and gastroduodenal operations(28.8%). The most common previous abdominal operation leading to a simple intestinal obstruction was appendectomy(39.0%), but the most common ones for a strangulated intestinal obstruction were a gastroduodenal operation(36.4%) and a gynecologic operation(36.4%). 4) The presence of continuous abdominal pain, rebound tenderness, localized tenderness, fever(>38oC) or the presence of 2 or more of the 6 classic findings(continuous abdominal pain, rebound tenderness, localized tenderness, fever(>38oC), tachycardia(>100/min), and leukocytosis(>10,000/mm3)) were more prevalent in the group with strangulated intestinal obstructions. 5) As for operative procedure, an adhesiolysis was done in 30 cases(31.3%), a resection of the small bowel in 18 cases(18.8%), a hernioplasty in 16 cases(16.7%), and a surgical reduction in 13 cases(13.5%). The most common operative procedure for a simple intestinal obstruction was an adhesiolysis, but that for a strangulated intestinal obstruction was a resection of the small bowel. 6) The incidence of postoperative complications was 14.5%. The incidence of postoperative complications for a simple intestinal obstruction was 9.9%, and that for a strangulated intestinal obstruction was 40%. The overall mortality rate was 2.1%.
Abdominal Pain ; Female ; Gyeongsangbuk-do ; Herniorrhaphy ; Humans ; Incidence ; Intestinal Obstruction* ; Male ; Mortality ; Postoperative Complications ; Surgical Procedures, Operative

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Comparison of the Clinical Results for Laparoscopic Cholecystectomy Versus Open Cholecystectomy.

Dae Jong CHANG ; Keun Soo LEE ; Jung Yul HWANG

Journal of the Korean Surgical Society.1998;54(5):715-722.

We compared 30 cases that had a laparoscopic cholecystectomy(L.C.) with 30 cases which revealed chronic cholecystitis on biopsy among the patients who had a standard open cholecystectomy(O.C.). The patients were treated at the Department of Surgery, Saint Columban Hospital, Mokpo, Korea, from January 1995 to July 1996. The results from the 60 patients are as follows: 1) The ratio of males to females was 1:2 in the L.C. group and 1:0.8 in the O.C. group. The prevalent age was the 6th decade in both groups. 2) Associated diseases were seen in 22 cases(73%) in the L.C. group and 20 cases(67%) in the O.C. group. 3) There were 6 cases(20%) of previous abdominal operations in the L.C. group and 7 cases(23%) in the O.C. group. 4) The mean operation time was 139.8+/-35.7 minutes in the L.C. group and 155.3+/-34.4 minutes in the O.C. group. 5) The mean hospital stay after the operation was shorter in the L.C. group(range: 4~7 days) than in the O.C. group(range:8~12 days). 6) Postoperative complications occurred in 2 cases(7%) in the L.C. group and 8 cases(27%) in the O.C. group. 7) The conversion rate from a laparoscopic cholecystectomy to an open cholecystectomy was 21%(8 cases). 8) Problem experienced during the laparoscopic cholecystectomy were bleeding at the operative field(4 cases), stone drop from gallbladder(3 cases), and bile leakage(1 case). 9) The time until postoperative oral intake was 2 postoperative days in the L.C. group and 4 postoperative days in the O.C. group. 10) The average duration of postoperative pain was 2.6+/-0.6 days in the L.C. group and 4.3+/-1.3 days in the O.C. group. 11) The average duration of narcotic requirement was 2.4+/-0.6 days in the L.C. group and 3.8+/-1.8 days in the O.C group.
Bile ; Biopsy ; Cholecystectomy* ; Cholecystectomy, Laparoscopic* ; Cholecystitis ; Female ; Hemorrhage ; Humans ; Jeollanam-do ; Korea ; Length of Stay ; Male ; Pain, Postoperative ; Postoperative Complications ; Saints

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A Comparison Between the Three-Trocar Technique and the Four-Trocar Technique in Laparoscopic Cholecystectomy.

Dong Eun PARK ; Kwon Mook CHAE ; Byung Joon SO ; Kyung Keun LEE

Journal of the Korean Surgical Society.1998;54(5):709-714.

The laparoscopic cholecystectomy has been clearly established as the gold standard for the surgical treatment of calculous biliary diseases. The currently used most popular technique is the four-trocar technique. This prospective study was designed to examine whether or not three-trocar technique could be chosen as an alternative to the standard four-trocar technique. Prospective data were collected on 98 patients undergoing a laparoscopic cholecystectomy at Wonkwang University Hospital from December 1995 to July 1996. We excluded 40 cases of acute cholecystitis which under went an operative cholangiogram with conversion to the four-trocar method as unfit for this study. We evaluated all associated clinical factors for the three-trocar technique (28 cases); and the four-trocar technique (30 cases), and we analysed the operating time, the intraoperative gallbladder perforation, postoperative complications, the postoperative hospital stay, and the duration for compliants of pain. Between the two techniques, there were no significant differences in the operating times, the postoperative complications, the postopeative hospital stays, and the durations for complaint of pain. However, intraoperative gallbladder perforation more frequently developed in the three-trocar technique than in the four-trocar technique (4 cases versus 1 case, P=0.02). However, gallbladder perforation didn't cause a prolonged operating time; or any other postoperative complication. In our series, the three-trocar technique had results similar to those of the four trocar technique. Morever, the three trocar technique was more economical and had cosmetic advantages. We conclud that a qualified laparoscopic surgeon can choose the three-trocar technique as an alternative to the four-trocar technique.
Cholecystectomy, Laparoscopic* ; Cholecystitis, Acute ; Gallbladder ; Humans ; Length of Stay ; Postoperative Complications ; Prospective Studies ; Surgical Instruments

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Laparoscopic Cholecystectomy in Patients with Liver Cirrhosis.

Jin Young JANG ; Ki Whan KIM ; Sun Whe KIM ; Yong Hyun PARK

Journal of the Korean Surgical Society.1998;54(5):701-708.

Liver cirrhosis is considered as a relative contraindication to laparoscopic cholecystectomy because of a bleeding tendency, the many dilated collateral vessels induced by portal hypertension, and general malnutrition. As experience with laparoscopic operations is accumulated and skills and instruments are developed, the number of conditions known as contraindications to a laparoscopic cholecystectomy is being limited. We compared 26 cases of laparoscopic cholecystectomies(L.C.) with 13 cases of open cholecystectomies(O.C.), which were performed on patients with liver cirrhosis at Seoul National University Hospital from 1992 to 1996. Demographic findings showed no statistical difference between the two groups. The mean operation time was 86 min. in the L.C. group and 117 min. in the O.C. group(p<0.05). The average number of analgesics injections was 5.5 in the O.C. group and 1.2 in the L.C. group(p<0.05). The postoperative hospital stay was 4.7 days in the L.C. group and 13.0 days in the O.C. group(p<0.05). The complication rate was 26.9% in the L.C. group and 46.2% in the O.C. group. When the patients were analyzed according to the Child classification, the patients in Child A had shorter postoperative hospital stays and a lower complication rate than those in Child B or C. Perioperative liver function changes were not significant in either group. In conclusion, liver cirrhosis is not a contraindication to L.C., and, in fact, L.C. should be considered first for the treatment of gallbladder stones in cirrhotic patients.
Analgesics ; Child ; Cholecystectomy, Laparoscopic* ; Classification ; Gallbladder ; Hemorrhage ; Humans ; Hypertension, Portal ; Length of Stay ; Liver Cirrhosis* ; Liver* ; Malnutrition ; Seoul

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